Role of Grassroots Public Health Leadership in Bedouin Society in Israel in Reducing Health Disparities

Introduction

Negev Bedouin settlements suffer from poor infrastructure, and the population's health status is low across all indicators. While it is difficult for Bedouin citizens of Israel to integrate into the Israeli employment market, integrating this population into the health system is far-reaching. The aim of this study is to analyze the barriers and motivational factors experienced by Bedouin doctors to promote public health in the Bedouin community in southern Israel and to examine the perceptions these doctors have around the concept of leadership in a public health setting.

Methods

We conducted semi-structured interviews with Bedouin doctors from the Negev Bedouin community and analyzed them using thematic analysis.

Results

Most interviewees saw themselves as leaders whose role was to improve public health in their community. They stressed the need for health leadership in Negev Bedouin society, and their desire to lead change in the community from within. All interviewees had grown used to a different way of life and a higher standard of living, and as a result, had difficulty returning home. Interviewees presented that trust in the health system is a critical factor for the success of health promotion programs. However, they noted the evolving trends of general mistrust in the government and its institutions that form the infrastructure for mistrust in the health system. Lack of time and workload were barriers to exercising leadership. Interviewees reported their perception of how socioeconomic status, the standard of living, and lack of infrastructure, education, and training affect health outcomes and collaboration potential.

Discussion

This study presents a unique perspective on the views of doctors from the Negev Bedouin population on their involvement with grassroots leadership as a strategy to reduce health disparities in this community.

Accelerating AI Innovation in Healthcare Through Mentorship

The adoption of Artificial Intelligence (AI) in the Canadian healthcare system falls behind that of other countries. Socio-technological considerations such as organizational readiness and a limited understanding of the technology are a few barriers impeding its adoption. To address this need, this study implemented a five-month AI mentorship program with the primary objective of developing participants' AI toolset. The analysis of our program's effectiveness resulted in recommendations for a successful mentorship and AI development and implementation program. 12 innovators and 11 experts from diverse backgrounds were formally matched and two symposiums were integrated into the program design. 8 interviewed participants revealed positive perceptions of the program underscoring its contribution to their professional development. Recommendations for future programs include: (1) obtaining organizational commitment for each participant; (2) incorporating structural supports throughout the program; and (3) adopting a team-based mentorship approach. The findings of this study offer a foundation rooted in evidence for the formulation of policies necessary to promote the integration of AI in Canada.

Shared Leadership for Total Worker Health in the Construction Industry

OBJECTIVE

The purpose of this study is to investigate the organizational, supervisor, team, and individual factors associated with employee and leader perceptions of shared Total Worker Health (TWH) transformational leadership in teams. Methods: We conducted a cross-sectional study with 14 teams across three construction companies. Results: Shared TWH transformational leadership in teams was associated with employees and leaders' perceptions of support from coworkers. Other factors were also associated it, but it differed by position. Conclusions: We found that leaders may be focused on the mechanics of sharing TWH transformational leadership responsibilities and workers may be more focused on their internal cognitive abilities and motivations. Our results suggest the potential ways of promoting shared TWH transformational leadership among construction teams.

A pilot study of changes in Total Worker Health® policies and programs and associated changes in safety and health climates in small business

BACKGROUND

There is little longitudinal research on whether changes to Total Worker Health® (TWH) policies and programs are associated with changes in health climate and safety climate. We hypothesize that as TWH policies and programs change, employees will report changes in safety climate and health climate from baseline to 1 year.

METHODS

Twenty-five diverse small businesses and their employees participated in assessments completed approximately 1 year apart. The exposures of interest, TWH policies and programs, were measured using the business-level Healthy Workplace Assessment™ which collects information on six benchmarks. The outcomes of interest, employee perceptions of safety climate and health climate, were measured via an employee survey. We employed paired t-tests and simple linear regression to assess change over a 1-year period.

RESULTS

The mean Healthy Workplace Assessment overall score changed by 11.3 points (SD = 11.8) from baseline to Year 1. From baseline to Year 1, the mean scores of each benchmark changed in a positive direction within this sample. The mean safety climate score and health climate score changed by +0.1 points (SD = 0.2) and +0.1 points (SD = 6.4) from baseline to Year 1, respectively. The associations between changes in the overall Healthy Workplace Assessment score and health climate and safety climate scores were negligible [β = 0.01 (95% confidence interval [CI]: 0.002, 0.02), and β = 0.01 (95% CI: 0.002, 0.02), respectively].

CONCLUSION

Our study suggests that when small businesses improve upon their TWH policies and programs they experience marginal measurable improvements in employee perceptions of their workplace safety climate and health climate.

Total Worker Health Leadership and Business Strategies Are Related to Safety and Health Climates in Small Business

The purpose of this study was to investigate the relationship between Total Worker Health® (TWH) business strategies and employee perceptions of leadership commitment and safety and health climates. Using data from 53 small enterprises and 1271 of their workers collected as part of the Small + Safe + Well (SSWell) Study, we confirm the primacy of the relationship between leadership commitment to safety and workplace safety climate. After accounting for leadership commitment to safety, business-reported policies and practices that promote the health, safety, and well-being of workers (i.e., TWH strategies) were no longer related to safety climate. In contrast, the relationship between TWH strategies and health climate were significantly associated with the level of small business leadership commitment to worksite wellness. Relatedly, our results demonstrate that leadership is a common correlate to both safety climate and health climate. Future research should investigate integrated TWH leadership development strategies as a means of simultaneously improving safety and health climates.

'Gender is not even a side issue…it's a non-issue': career trajectories and experiences from the perspective of male and female healthcare managers in Kenya

Women comprise a significant proportion of the health workforce globally but remain under-represented in the higher professional categories. Concern about the under-representation of women in health leadership positions has resulted in increased research on the topic, although this research has focused primarily on high-income countries. An improved understanding of the career trajectories and experiences of healthcare leaders in low- and middle-income countries (LMICs), and the role of gender, is therefore needed. This qualitative case study was undertaken in two counties in coastal Kenya. Drawing on the life-history approach, 12 male and 13 female healthcare leaders were interviewed between August 2015 and July 2016 on their career progression and related experiences. Although gender was not spontaneously identified as a significant influence, closer exploration of responses revealed that gendered factors played an important role. Most fundamentally, women’s role as child bearers and gendered societal expectations including child nurturing and other domestic responsibilities can influence their ability to take up leadership opportunities, and their selection and appointment as leaders. Women’s selection and appointment as leaders may also be influenced by positive discrimination policies (in favour of women), and by perceptions of women and men as having different leadership styles (against women, who some described as more emotive and reactive). These gendered influences intersect in relatively invisible ways with other factors more readily identified by respondents to influence their progression and experience. These factors included: professional cadre, with doctors more likely to be selected into leadership roles; and personal and professional support systems ranging from family support and role models, through to professional mentorship and continuing education. We discuss the implications of these findings for policy, practice and research, including highlighting the need for more in-depth intersectionality analyses of leadership experience in LMICs.

Global health leadership training in resource-limited settings: a collaborative approach by academic institutions and local health care programs in Uganda

INTRODUCTION

Due to a limited health workforce, many health care providers in Africa must take on health leadership roles with minimal formal training in leadership. Hence, the need to equip health care providers with practical skills required to lead high-impact health care programs. In Uganda, the Afya Bora Global Health Leadership Fellowship is implemented through the Makerere University College of Health Sciences (MakCHS) and her partner institutions. Lessons learned from the program, presented in this paper, may guide development of in-service training opportunities to enhance leadership skills of health workers in resource-limited settings.

METHODS

The Afya Bora Consortium, a consortium of four African and four U.S. academic institutions, offers 1-year global health leadership-training opportunities for nurses and doctors. Applications are received and vetted internationally by members of the consortium institutions in Botswana, Kenya, Tanzania, Uganda, and the USA. Fellows have 3 months of didactic modules and 9 months of mentored field attachment with 80% time dedicated to fellowship activities. Fellows' projects and experiences, documented during weekly mentor-fellow meetings and monthly mentoring team meetings, were compiled and analyzed manually using pre-determined themes to assess the effect of the program on fellows' daily leadership opportunities.

RESULTS

Between January 2011 and January 2015, 15 Ugandan fellows (nine doctors and six nurses) participated in the program. Each fellow received 8 weeks of didactic modules held at one of the African partner institutions and three online modules to enhance fellows' foundation in leadership, communication, monitoring and evaluation, health informatics, research methodology, grant writing, implementation science, and responsible conduct of research. In addition, fellows embarked on innovative projects that covered a wide spectrum of global health challenges including critical analysis of policy formulation and review processes, bottlenecks in implementation of national HIV early infant diagnosis and prevention of mother-to-child HIV-transmission programs, and use of routine laboratory data about antibiotic resistance to guide updates of essential drug lists.

CONCLUSION

In-service leadership training was feasible, with ensured protected time for fellows to generate evidence-based solutions to challenges within their work environment. With structured mentorship, collaborative activities at academic institutions and local health care programs equipped health care providers with leadership skills.